KEY TEACHING POINTS

•The likelihood of ventricular arrhythmias in Brugada syndrome is increased at times when vagal tone is high. Thus, arrhythmic syncope in these patients can be confused with neurocardiogenic syncope, especially if Brugada electrocardiogram signs are intermittent. •The recovery phase of the exercise test and Holter recordings during sleep provide a good opportunity to observe vagally mediated ST elevations and could provide important diagnostic information whenever Brugada syndrome is suspected. •Atrial fibrillation is the most common atrial arrhythmia in patients with Brugada syndrome and may be its first manifestation; it is associated with unfavorable prognosis. Brugada syndrome should be excluded in young patients with atrial fibrillation and normal heart and electrocardiogram, because administration of class IC antiarrhythmic agents may cause ventricular arrhythmias and cardiac arrest.